Monoclonal antibodies for treating early Alzheimer’s disease
Medicare Part B (Medical insurance) may cover FDA-approved monoclonal antibodies for treating Alzheimer’s disease, if you're eligible
Description
Monoclonal antibodies may slow or delay symptoms of Alzheimer’s disease, but they don’t cure or reverse the disease.
Coverage details
Part B maycover FDA-approved monoclonal antibodies (like Leqembi, generic name lecanemab, or Kisunla, generic name donanemab) that target beta-amyloid plaques for treating Alzheimer’s disease.
Medicare coverage of these monoclonal antibodies requires your doctor or other health care provider to collect evidence about how well the monoclonal antibodies work for a qualifying study or registry. The information your provider collects will help answer treatment questions and describe how well the monoclonal antibodies works for you. Talk to your provider to find out if monoclonal antibodies for treating early Alzheimer’s disease are right for you.
Who's eligible
Your provider must confirm you have beta-amyloid plaques consistent with Alzheimer’s disease, and they must diagnose you with one of the following:
- Mild cognitive impairment due to Alzheimer’s disease
- Mild dementia due to Alzheimer’s disease
If you don’t meet the Part B coverage criteria for an FDA-approved monoclonal antibody for treating early Alzheimer’s disease, your Medicare drug coverage (Part D) plan might cover it. Contact your plan for more information.
Costs
After you meet the Part B deductible , you pay 20% of the Medicare-approved amount for Part B-covered monoclonal antibodies.
You may need scans and tests before or during treatment that might add to your costs. Talk to your provider for more information.
Facility
The drug is given intravenously (through a vein) in a provider’s office or other outpatient setting.
Ask your doctor or healthcare provider how much your test, item, or service will cost.
Your doctor may recommend services that Medicare does not cover or offers too frequently. This could end up in additional costs for you. Make sure to ask your doctor about the reasons for these recommendations and what Medicare will actually cover.
Specific amounts you could owe depend on:
Other insurance you may have
How much your doctor charges
If your doctor accepts assignment
The type of facility
Where you get your test, item, or service